Neonatology

Leadership

Overview

Mission Statement

We will improve the neonatal outcome of pregnancy by:

  1. Providing outstanding evidence-based neonatal clinical care
  2. Educating the next generation of neonatal caregivers
  3. Advancing neonatal scholarship

Clinical Programs

University of Washington Medical Center Neonatal Intensive Care Unit (Level IV):

Thomas P. Strandjord, MD, Medical Director; Toby Cohen, MD, Associate Medical Director

The UWMC NICU admits critically-ill newborns from one of the highest risk obstetric services in the nation. The multi-professional perinatal and NICU teams have special expertise in management of the most fragile growth-restricted and premature fetuses and newborns. The high-risk perinatal program receives obstetrics referrals from throughout the WWAMI region for fetal abnormalities, severe maternal illness, and extreme prematurity and is the site of delivery for the most complex birth defects, including infants requiring EXIT procedures for airway anomalies. Additional advanced services include therapeutic hypothermia and the full range of ventilation strategies including inhaled nitric oxide, high –frequency oscillatory and jet ventilation. The NICU medical team includes neonatal faculty, neonatal fellows, neonatal nurse practitioners, neonatal hospitalists, pediatric residents, interns and medical students. The inter-professional team includes dedicated respiratory therapists, neonatal pharmacists, dieticians, physical therapists, speech language pathologists and social work support.  The nursing team includes three tiers of RN expertise and leadership. A state-of-the-art 50-bed NICU opened October 2012. The NICU includes 42 single-bed rooms with space for a family member to stay with their infant plus several additional rooms for multiples as well as an integrated OR for surgical procedures. Patients are cared for by one of two multi-disciplinary teams, a resident-based team, and an NNP/hospitalist team. The UWMC NICU’s care model includes 24/7 coverage by in-house residents and, mid-level intensivists (fellow or NNP/hospitalist), under the direction of attending neonatologists. In AY 2018, the UWMC had 1910 deliveries with 509 NICU admissions. The average daily census was 37 with 21 preterm infants weighing less than 1500 grams at birth and an average daily census of 3.7 on ventilators.

Seattle Children’s Hospital Neonatal Intensive Care Unit (Level IV):

Robert DiGeronimo, MD, Medical Director; Zeenia Billimoria, MD, Associate Medical Director

The Neonatal Intensive Care Unit at Seattle Children’s Hospital is the highest rated Level IV NICU in the Seattle area and serves as the major tertiary referral center for medically and surgically complex neonates in the Pacific Northwest. Seattle Children’s NICU admits nearly 500 patients annually and has over 500 affiliated faculty that represent all pediatric subspecialties including; 12 pediatric surgeons, 5 pediatric neurosurgeons and 4 pediatric cardiac surgeons – more than any other hospital in the region. The Children’s NICU provides the full spectrum of neonatal medical care including therapeutic hypothermia for acute hypoxic ischemic encephalopathy, seizures, high frequency ventilation, inhaled nitric oxide and ECMO for severe respiratory failure, renal replacement therapy including dialysis and surgical expertise in the areas of congenital diaphragmatic hernia, intestinal failure, bowel atresia, craniofacial anomalies, reconstructive pelvic medicine, post-hemorrhagic hydrocephalus, neural tube defects and neurovascular malformations. In addition, we offer multidisciplinary care teams providing neuro-critical care and management of bronchopulmonary dysplasia. Daily rounds with the medical team incorporate the patient’s family, NICU nurses, dietician, pharmacist and respiratory therapist.  The NICU team accepts admissions of critically ill neonates up to 44 weeks’ post menstrual age (i.e., up to 4 weeks after due date) from the 5-state WAMI region. The Seattle Children’s Hospital NICU’s care model includes an in-house fellow or NNP and attending neonatologist 24/7. Seattle Children's Prenatal Diagnosis and Treatment Program partners with the University of Washington to provide care for pregnant women and their families when pregnancy is complicated by known or suspected conditions in the developing fetus. Our program integrates obstetric, neonatology and pediatric specialty care for families facing complicated pregnancy management or decision-making.  In AY 2018, the SCH NICU had 483 admissions. The average daily censures was 26.8 with 69 preterm infants weighing less than 1500 grams at birth and 14 ECMO days.

UW Medicine/Northwest Hospital and Medical Center Neonatal Intensive Care Unit (Level II):

Toby L Cohen, MD, Medical Director; Thomas P. Strandjord, MD, Associate Medical Director

In November of 2018 Northwest Hospital Special Care Nursery, a Level II NICU began a collaborative effort with the UW Division of Neonatology and Seattle Children’s Hospital to support care for infants born prematurely at greater than 32 weeks, as well as term infants who may be suffering from a variety of neonatal conditions including but not limited to breathing difficulties and infections. Northwest Hospital delivery service sees approximately 1100 newborn infants annually. Although historically the service delivers primarily low risk patients there is always the potential need for the expertise provided by 24/7 in house coverage by our team of Advanced Neonatal Practitioners who have immediate access to consultation with UW/SCH neonatologists and a premier critical care neonatal transport system. The unit is being remodeled to support the focus on family centered care with increased opportunity and available space for couplet care.

UW Medicine/Valley Medical Center Neonatal Intensive Care Unit (Level III)

Christina Long, DO, Medical Director; Shilpi Chabra, MD, Associate Medical Director

In July 2017, Neonatologists and Advanced Neonatal Practitioners from University of Washington/Seattle Children’s Hospital began a collaborative effort to staff the NICU at UW/Valley Medical Center. The unit has a 29-bed capacity. The single bed rooms provide space and privacy for our patients and their families. Two, unique, infant stabilization rooms allow immediate resuscitation of infants in the NICU after birth without requiring transport after stabilization. Valley has a robust high- risk perinatal clinic and the Neonatologists work closely in conjunction with the high-risk team to provide consults for families prenatally.  The Valley NICU uses a multi-disciplinary approach to patient care with NICU dedicated pharmacists, dieticians, physical therapists, speech therapists, respiratory therapists, social work, and NICU nurses. This multi-disciplinary staff meets with families to provide the best family-centered care for our patients. Advanced services provided at Valley include therapeutic hypothermia with 24/7 Pediatric Neurology support and a large range of ventilation strategies including high-frequency oscillatory ventilation. Advanced Neonatal Practitioners staff the NICU with 24/7 in- house coverage under the direction of attending Neonatologists. In AY 2018, Valley had 3474 number of deliveries with 212 NICU admissions.

Providence Regional Medical Center Everett Neonatal Intensive Care Unit (Level III):

Michael D. Neufeld, MD, MPH, Medical Director; Anna Hedstrom, MD, Associate Medical Director

Providence Regional Medical Center Everett’s 29-bed capacity NICU opened on Mother’s Day in 2002. The unit was developed through the efforts of an alliance between PRMCE and Seattle Children’s Hospital. Individual rooms provide privacy for patients and their families. The multidisciplinary team meets daily with parents and concentrates on family-centered care, teaching parents how to take care of their infants, especially those with special needs. In preparation for discharge, parents are provided in-depth instruction on how to manage emergencies that may arise in the home, including the need for CPR. The care model at PRMCE is 24/7 in-house Advanced Neonatal Practitioners under the direction of attending neonatologists. In AY 2018, PRMCE had 4603 deliveries with 602 NICU admissions. The average daily census was 22.5 with 49 preterm infants weighing less than 1500 grams at birth.

Franciscan Health Care System; St Joseph Medical Center (Level III); St Francis (Level II); Highline Medical Center (Level II):

Stephen Welty, MD, Medical Director; Meenakshi Dutta MD, Highline Medical Director

Franciscan Health Care System includes a network of hospitals with approximately 9,000 deliveries annually at its 5 obstetrical facilities: St Joseph Medical Center in Tacoma, St Francis Hospital in Federal Way, St Elizabeth Hospital in Enumclaw, Harrison Medical Center in Silverdale, and Highline Medical Center in Burien. St Joseph Medical Center has a licensed capacity of 23 neonatal beds and has 24/7 in-house Advanced Neonatal Practitioners supported by faculty neonatologists. St. Francis Hospital has a licensed capacity of 10 Level II beds that receive medical care from local pediatricians, with consultation and attendance at high-risk deliveries as needed from SCH Advanced Neonatal Practitioners and/or neonatologists. For 12 hours/day, Saint Francis has in house coverage with the Advanced Neonatal Practitioners with support from Neonatology Providers and for the other 12 hours/day, Neonatology provides coverage directly and via telemedicine. Highline Medical Center has a licensed capacity of 5 Level II beds, with inpatient Level II care and consultative services provided by Seattle Children’s Neonatologists on call. St. Elizabeth is a critical access hospital with 345 deliveries a year. Seattle Children’s Hospital partnered with the Franciscan Health Care System to begin providing Neonatology services and medical direction on April 1, 2013, and St. Joseph Medical Center opened its new Level III NICU in June 2013, and Highline Medical Center began its collaboration with Seattle Children’s in November 2018. This partnership has made it possible for the vast majority of patients to stay within their community while receiving excellent care for their fragile newborns. On 1/22/18, we lowered the gestational age at which we would manage patients at SJMC to 25 weeks when previously we had used 27 weeks gestation for our threshold of care at SJMC. With the continued emphasis on non-invasive ventilation as our primary mode of respiratory support, we average between 4 and 6 babies on nasal CPAP per day and less than one baby per day on invasive ventilatory support. In September of 2018, we expanded our care to provide inhaled nitric oxide for infants with hypoxic respiratory failure and we utilized it on three patients with excellent clinical responses. In AY 2018, St. Joseph’s had approximately 4100 deliveries with 480 NICU admissions. Our average daily census was 17.0 with 44 premature infants weighing less than 1500 and 14 weighing less than 1000 grams at birth.

Research Programs

Research Programs

Our division faculty have research focused on neuroscience, medical education, global neonatal-perinatal health, and ethics. 

Neuroscience. Current NIH-funded bench research programs are focused on neurodevelopment, neonatal neuroprotection, and biomarker development using state of the art techniques. We use a combination of in vitro platforms and animal models, including rodents, ferrets and non-human primates in our work. Our work in erythropoietin (Epo) neuroprotection has translated from bench to bedside, and we now lead 2 NIH-funded multicenter randomized controlled trials of infants at high risk of neurodevelopmental impairment. The first, titled “Preterm Epo Neuroprotection trial” (PENUT Trial, NCT01378273) is testing the efficacy of Epo neuroprotection in 941 extremely low gestational age neonates. Enrollment is complete, and neurodevelopmental assessments at 2 years of age are ongoing. The second trial, “High Dose Epo for Asphyxia and Encephalopathy” (HEAL, NCT# 02811263) will enroll and randomize 500 term neonates with hypoxic ischemic encephalopathy, to evaluate neurodevelopmental outcomes at 2 years of age. Enrollment is currently ongoing.

With a goal of translating and disseminating neuroscience research to the medical community, the Division of Neonatology organized a Brain Research Advancement in Neonatology (BRAIN) Program. The mission of BRAIN is to improve neonatal neurodevelopmental outcomes through neuroprotection-focused research and clinical application. the program's vision is to provide evidence-based national leadership in neonatal neurologic care and scholarship. The specific aims of the BRAIN Program are to 1) Improve neonatal neurodevelopmental outcomes through evidence-based research, 2) Investigate new neuroprotective therapies, 3) Support clinical evaluation and application of evidence-based therapeutics, and 4) Promote educational scholarship in the next generation of neonatal care providers.

Medical Education. In 2014, the Division of Neonatology joined an elite group of neonatal divisions who own and operate a dedicated neonatal simulation program. The Neonatal Education and Simulation-based Training (NEST) Program sets the UW and Seattle Children’s Division of Neonatology apart and highlights the Division’s dedication to high-quality, evidence-based education. The mission of the NEST Program is to improve neonatal outcomes through advanced technology-enhanced training and simulation research.  The program’s vision is to provide international leadership in neonatal education, simulation-based training and scholarship. The specific aims of the NEST Program are: 1. Improve neonatal outcomes through individual and interprofessional education, 2. leverage emerging technologies for simulation-based training and research, 3. define optimal processes for neonatal resuscitation, 4. investigate methods to enhance the acquisition and retention of technical and behavioral skills, and 5. promote educational scholarship in the next generation of neonatal care providers. Current projects include: ‘boot camps’ for residents and fellows, neonatal resuscitation training, neonatal procedural skills training, development of a computer-based perinatal counseling simulator, and virtual reality neonatal disaster training. The NEST program works to improve the care of neonates in the Seattle region by conducting educational outreach with community providers and neonatal transport teams.

Global neonatal-perinatal health. Research in this area focuses on the generation, integration, and implementation of evidence-based policy, research and program aspects of reproductive, maternal, newborn, child health and nutrition, globally and in building local country capacity. Our faculty include members who are widely regarded as a global leaders in the field of maternal, newborn child health and nutrition (MNCHN) who have partnered with a broad cross-section of stakeholders including United Nations agencies such as the World Health Organization and UNICEF, private foundations, academic centers and non-governmental organizations.

Ethics. A burgeoning area of research in our division is in the area of medical decision-making, with a special focus on parents as decision makers for their sick infants in the neonatal intensive care unit (NICU).

Training Programs

Neonatal-Perinatal Fellowship Program

Megan Gray, MD, Program Director; Taylor Sawyer, DO, MEd, Associate Program Director

The Neonatal-Perinatal Medicine Fellowship Training Program at the University of Washington began in the mid-1960s. Our mission is to educate and inspire the next generation of neonatologists who will provide state-of-the-art, evidence-based clinical care, and to assist and mentor them in finding and pursuing their scholarly passion so they are poised to be the future academic leaders of our field.  During their 3 years of training, fellows spend a total of 56 weeks on clinical service: 46 weeks on rotations in the two teaching hospital NICUs (Seattle Children's Hospital & University of Washington Medical Center); 8 weeks on clinical services including perinatology, cardiac ICU, and pediatric surgery; and 2 weeks in one of the Division's community hospital NICUs. Fellows also attend NICU follow-up clinic 8 half-days each year. Additionally, fellows achieve a high degree of scholarly/ academic competence in order to excel in a career in academic neonatology. We have designed our program to provide ample protected time for scholarly activities. Our research areas of focus include neuroscience, global health, education/simulation, quality improvement, and biomedical ethics. We have strong research mentors both within and outside the Neonatology Division.  As of 2018, 62 neonatologists have successfully completed their clinical and research training in our program, and more than 50% have pursued an academic career. Our graduates have a first time board pass rate of 100% over the past 5 years.